by Pia K. Hansen
Every pregnancy is amazing, miraculous and incredible. Just think about it: a new human being is taking shape inside a woman's body, and it only takes nine months.
When time comes for delivery, brace yourself for another miracle. Not only does the baby come from water into air, knowing how to breathe all on its own, but the mother's body undergoes quite a transformation to make the birth possible. Throughout the pregnancy, the cervix (which surrounds the opening to the uterus) has held tight against pressure from the growing baby and the fluid surrounding it inside the uterus. When delivery approaches, the tiny hole in the middle of the cervix — it's usually no more than the circumference of a pencil — has to expand to a full 10 centimeters (almost four inches) to allow the baby to be born. This is obviously a process mom can feel.
Many women are determined to deliver without pain medication because they believe it might hurt the baby, if they take drugs such as painkillers during birth. But when the contractions really take off, some change their minds because the pain is more than they bargained for.
"Some women are not comfortable feeling this type of dynamic [labor] in their bodies," says Maggie Reisenauer, a nurse who works in childbirth education and at Sacred Heart's Birth Place. "Everybody's pain is their own pain or discomfort. You must respect that it's not my pain, it's not the husband's pain, not anybody else's pain — you have to respect that individual person's pain."
Reisenauer has been a nurse for more than 23 years and worked in childbirth for more than 18 of those years. "I know I must have delivered hundreds of babies, but I really don't know how many," she says.
Reisenauer works not only in labor delivery, but also with high-risk pregnancies — typically mothers who are on bed rest in the hospital because they are at risk for delivering too early. She also works with moms and babies after the delivery. She says there is a special connection between the nurses in the maternity ward and the women in labor.
"When I work with someone, I really want them to deliver on my shift — you really bond with them when you are there through the labor," says Reisenauer. "Obviously, it doesn't always go that way. Sometimes no one delivers during my shift, other times we have many women delivering at the same time — there really is no constant to my job."
Reisenauer says the attitude to pain relief during childbirth really hasn't changed in the time she has worked with deliveries. Many women do want a natural delivery with as few drugs and as little medical intervention as possible, but some are surprised by the amount of preparation that takes.
"Natural childbirth is a very involved process. Education has to start early if the mom wants to do a natural childbirth, but I often don't see people until they are in their early 30s week," says Reisenauer. (Ideally, women should deliver before they reach the 40th week of pregnancy.) "By then, many women have heard that childbirth is just horribly painful and that they must get an epidural — it's often too late for me to counteract that information."
She always makes a plan with expectant mothers when they come in, and she does not push any drugs on them.
"If they don't want to do medication, I agree to not bring it up until the mom herself asks for it. It's my job to help the mom manage her pain the way she wants to manage it," says Reisenauer.
The Epidural -- An epidural is the most common form of pain relief during labor and delivery. It's pain medication that's injected through a catheter on a continuous basis into the space that lies between the spinal cord and the vertebrae in the spine of the mom.
"It's an anesthesia that offers pain relief from the belly button and down to the toes," says Reisenauer. "With an ideal epidural, mom still feels pressure during the contractions but it's no longer painful. She should also be able to move around in bed and help position herself comfortably during the birth."
While widely used in hospitals across the country, some studies show that epidurals can have side effects, however. For instance, researchers at the University of Texas' Southwestern Medical Center at Dallas found that epidurals are associated with prolonged labor, increased risk for uterine infection and a higher rate of operative procedures such as forceps deliveries and Caesarean sections. The six-month study was published in OB/Gyn Journal in 1995 and was the largest of its kind, surveying 889 randomly selected women with uncomplicated pregnancies. Still, regardless of the findings, the research team recommended epidurals as a more effective method of pain relief during childbirth.
The most common side effect is what Reisenauer refers to as an epidural headache. "It's really severe, like a migraine, but there are no long-term effects," she explains.
As for effects on the baby, some studies show that babies delivered while Mom had an epidural are slower at becoming efficient at breastfeeding, says Reisenauer.
"If the baby is put to the breast within the first hour of the delivery, while the baby is really interested, that certainly helps the baby become better at breastfeeding," she explains, adding that very little of the medication is transferred to the baby.
"The epidural itself is not as readily picked up by the mom's body or by the baby's body. As with any other medication, the shorter period you use it in, the better," says Reisenauer.
It's true, she says, that some women may have a harder time actually pushing the baby out with an epidural, because they can't feel the baby's progression or how to push.
"It's hard to explain to someone how to push. It's the same muscles as the ones you used for a bowel movement," says Reisenauer. "Some women just get it, and they just push that baby right out. With others, it takes a little more time."
She says they do a lot of epidurals but is unsure of how many — still, it's more than 50 percent of deliveries, she says.
Another form of pain relief is intravenous narcotics, which are typically given earlier on in labor — before five centimeters' dilation.
"It may make mom feel a little euphoric. I always tell the women that it's going to make their heads feel a little funny before it helps the pain — there's a sense of loss of control. None of us really like to feel that way," says Reisenauer. Some narcotics do not have that effect.
Narcotics do affect the baby, as they are transferred via the placenta to the baby. In general, the drugs used today are more efficient and are offered in a manner that doesn't interfere as much with either mom or the baby.
"IV narcotics and epidurals have always been provided. What has changed is the type of drugs that we use and in some cases how we use them," says Reisenauer. "We have become better at giving good epidurals that give mom a good block, but doesn't leave her completely without any feeling. Some narcotics [with side effects] have been taken completely off the market."
Inducing Labor -- A recent study out of the University of New Mexico Health Sciences Center in Albuquerque showed that one in five babies is now born after the mother's labor has been induced. That's a doubling since 1990. Researchers William Rayburn and Jun Zhang published an article in the journal Obstetrics and Gynecology after having reviewed extensive research and statistics about the induction of labor. Rayburn and Zhang concluded that in about half the cases, the reason for induction is not medical — it's done out of convenience for the mother, the family or the doctor. The family, for example, may worry about the baby's health, write Rayburn and Zhang, while the doctor might worry about anything going wrong and the cost of a malpractice suit.
But in October of last year, fetal medicine expert Karen Kaufman at Northwestern University Medical School reported in The American Journal of Obstetrics and Gynecology that inducing labor often increases the time the woman spends in the hospital, as well as her need for pain medication during the delivery — making for a much costlier and more medicated birth altogether.
"Women should not be asking to be induced just for the sake of convenience," Kaufman wrote.
Reisenauer divides reasons for inducing labor into mom and baby reasons. "Mom reasons can be diabetes, chronic hypertension or high blood pressure developed during pregnancy," she says. "There can be concern about the baby getting too large, or we can be dealing with a post-date. Baby reasons can be that they baby is getting too big — yes, that does happen — or that the baby is too little, that there is too little fluid around the baby or around the cord to cushion it."
Pitossin is the most common drug used to induce labor. "We try to regulate the pitossin so mom has contractions every two to three minutes. It's important that there is a break between contractions, for mom to catch her breath, but also for the baby. The baby gets much better blood flow between contractions than during contractions," says Reisenauer.
Induced labor in general takes closer monitoring of both baby and mom, but pitossin does not affect the baby.
"If we overstimulate the uterus, it can have an affect on the baby, because of the contractions," says Reisenauer, explaining that heavy and very frequent contractions can have a negative effect on the baby.
A Healthy Baby -- What works for one woman, may not work for the other. Women who go into labor wanting a medication-free delivery but end up getting "something" sometimes become frustrated or even angry.
"It's not our fault and it's not your fault, it's just how it sometimes goes," says Reisenauer. "Sometimes they get over it and accept it — sometimes they never do."
But she says the point of it all is to deliver a safe and healthy baby. And the best way to do that, she says, is to take good care of mom while she's pregnant.
"I can't say often enough how important prenatal care is. Many problems or risk factors can be discovered during prenatal visits, and that makes us much better prepared for labor and delivery," says Reisenauer. "We can go very low tech or very high tech — it all depends on what mom needs and what the baby needs. Our focus is that the outcome is a healthy mom and a healthy baby."
Publication date: 02/13/03
